Kidney function (creatinine/eGFR, BUN, urine albumin-to-creatinine ratio)

Pick Ordered or Not ordered to see the note.

Indicated when

• —Diabetes, hypertension, cardiovascular disease, or other recognized risk factors for chronic kidney disease, where periodic evaluation of kidney function is part of guideline-directed, risk-based risk assessment rather than general population screening [6]
• —Symptoms or findings suggestive of kidney disease, such as unexplained edema, or as part of an initial work-up for persistent tiredness alongside other tests
• —Monitoring a medication that affects kidney function or that requires dose adjustment based on kidney function

Not indicated when

• —Routine annual or 'wellness panel' screening of creatinine/eGFR or urine albumin-to-creatinine ratio in an asymptomatic adult with no diabetes, hypertension, cardiovascular disease, or other chronic kidney disease risk factor [7]

Why not

In a low-risk adult with no symptoms or risk factors, an isolated mildly reduced eGFR or borderline urine albumin result is common and often not reproducible, and can generate unnecessary repeat testing or referral without changing management [7].

Better first step

In adults with diabetes, hypertension, or cardiovascular disease, periodic creatinine/eGFR and urine albumin-to-creatinine ratio is the risk-based approach current CKD guidance directs testing toward [6]; in adults without these risk factors, kidney function testing is not a default part of periodic bloodwork.

Typical ND rationale

An ND may include creatinine and other kidney markers in a wellness panel, reasoning that kidney disease is often silent until advanced, so checking kidney function regularly, even without symptoms, is a reasonable precaution.

Ontario coverage & CONO orderability

OHIP status

insured_conditional

Creatinine (L067) and urea nitrogen/BUN (L251) are listed by name in the 2026 Schedule of Benefits for Laboratory Services and insured when ordered by a physician, midwife, or NP who has clinically assessed the patient; ND-ordered testing is patient-paid regardless (Reg. 552 s.22(1); SOB-LS 2026 preamble). No separate line item for urine albumin-to-creatinine ratio (microalbumin/ACR) was located in the 2026 Schedule in this session's review, so its OHIP status is unverified; likewise, no separate Schedule line item for estimated GFR was found, consistent with eGFR ordinarily being a calculated value reported alongside creatinine rather than a separately billed test, though this session did not independently verify that administrative point from the Schedule text itself.

CONO orderable

Yes — CONO list #50, #70, #30, #31

CONO list item 50, blood: 'Creatinine'; item 70, blood: 'Glomerular Filtration Rate (GFR)'; item 30, blood: 'Blood Urea Nitrogen (BUN)'; item 31, blood: 'Bun / Creatinine Ratio.' Urine albumin-to-creatinine ratio (microalbumin) was not found as a distinct item on the CONO list reviewed for this record.

Linked conditions

• diabetes ↗
• tired ↗

Counselling script

“If you have diabetes, high blood pressure, or heart disease, checking your kidney function regularly is genuinely worthwhile, since kidney disease can be silent until it's advanced, so I'll order that today. Without one of those risk factors, I don't think kidney testing needs to be part of routine yearly bloodwork, since an isolated result in a low-risk person is usually not meaningful. If you're ever diagnosed with diabetes or high blood pressure, we'll start monitoring your kidneys as part of that.”

Revisit if

• —New diagnosis of diabetes, hypertension, or cardiovascular disease
• —New symptoms suggestive of kidney disease
• —Starting a medication that affects or requires monitoring of kidney function

References

1. [1]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkCreatinine (L067) is listed by name in the 2026 OHIP Schedule of Benefits for Laboratory Services
2. [2]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkUrea nitrogen/BUN (L251) is listed by name in the 2026 OHIP Schedule
3. [3]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkCommunity lab tests are insured only when ordered under the Schedule by an authorized prescriber
4. [4]Government of Ontario (e-Laws) (2026). Health Insurance Act, R.R.O. 1990, Reg. 552: General, s. 22 (insured laboratory services). linkA lab test is insured only when ordered by a physician, midwife, or NP who has clinically assessed the patient
5. [5]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkTests ordered by anyone other than an authorized provider, including NDs, are not insured services
6. [6]Kidney Disease: Improving Global Outcomes (KDIGO) (2024). Executive summary of the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease: known knowns and known unknowns. linkThe KDIGO 2024 guideline's scope includes chapters dedicated to the evaluation and risk assessment of people with chronic kidney disease
7. [7]College of Family Physicians of Canada / Choosing Wisely Canada (2026). Family Medicine: Fifteen Tests and Treatments to Question. linkDon't do annual screening blood tests unless directly indicated by the patient's risk profile